Bargain CT Scans For Smokers: More Harm Than Good?

August 17, 2011

Hospitals around the country have started offering deeply discounted CT scans for smokers worried about lung cancer.

Their pitches point to recent findings that screening current or former heavy smokers with CT scans before they show symptoms of lung cancer could modestly reduce their risk of dying from the disease. But some experts question whether the strategy is simply a marketing ploy that could bring more harm than good.

A flyer from St. Luke's Hospital in Bethlehem, Pa., heralds that a "10-second scan could be life-saving" — and comes with a coupon for a $49 procedure. On the website for University Hospitals in Cleveland, there's a slick video promoting a $99 scan, noting that some experts say the screening could be the "new hope needed to help save lives."

The promotions come in response to a National Cancer Institute study of more than 50,000 smokers published last fall. It found that annual, low-dose computerized tomography screening of high-risk patients could cut the death rate from lung cancer by 20 percent by identifying the disease earlier than X-rays.

In the nearly decade-long study, 354 patients who got CT scans died of lung cancer, compared with 442 deaths among those who got chest X-rays.

"The data [are] pretty compelling," said Dr. Christopher Faber, medical director of the University of Pittsburgh Comprehensive Lung Center, one of the hospitals offering low-cost CT scans. So compelling that federal officials halted the study early so they could announce the findings.

But as Shots reported at the time, the findings come with important caveats. For one, the results apply only to older smokers (55 to 75) and former smokers who lit up at least a pack of cigarettes a day for 30 years.

There's also the risk of false positives: Nearly one in four people in the study had scan that found an abnormality in the lung which turned out not to be cancer. That often can lead to a biopsy or other invasive procedures with their own health risks. Another concern: the added radiation exposure from the scans.

There are economic considerations, too: The results of the study suggest that more than 300 heavy smokers will need to be screened to prevent just one death from lung cancer over a five-year period.

Most lung cancers are detected when they cause symptoms such as shortness of breath, and by that time, the disease is more likely to be advanced and less curable. William Burfeind, a cardiothoracic surgeon at St. Luke's, says his hospital hopes the low-cost scans will help identify patients with earlier stages of lung cancer. Those patients might have a better chance of being cured by treatment.

"The vast majority of my patients show up with stage 3 or 4 [lung cancer,] which is treatable, but rarely curable," he says. "Once we learned the results of the national study, we felt compelled to offer this to our patients."

Hospitals have marked down the CT scan – which typically costs as much as $1,000 – to help cash-paying customers. The test isn't covered by Medicare or private insurers. Neither the American Cancer Society nor the U.S. Preventive Services Task Force, an independent panel of medical experts that examines the effectiveness of preventive tests, recommends the screening, although both groups are studying the issue.

"You have to ask the question: Whose interests are being served here?" Dr. H. Gilbert Welch, a Dartmouth researcher who studies cancer screening, says of hospitals' sales pitches. "Screening tests are a great way to recruit new patients that produce revenues with follow-up biopsies and procedures."

Other experts worry that the hospital promotions may induce patient to get a test they don't need.

Dr. David Midthun, a pulmonologist at the Mayo Clinic in Minnesota, says the NCI findings prove that on an individual basis, CT scans are a good idea. What's not known, he says: Considering the cost of the test, does it make sense to recommend it for millions of people?